Provider Demographics
NPI:1881347441
Name:SOUTH TEXAS DIRECT KIDS LLC
Entity type:Organization
Organization Name:SOUTH TEXAS DIRECT KIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIRGILIO
Authorized Official - Middle Name:VAZQUEZ
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:SLP-CCC
Authorized Official - Phone:956-324-9014
Mailing Address - Street 1:1405 JACAMAN RD STE 106
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6225
Mailing Address - Country:US
Mailing Address - Phone:956-602-1390
Mailing Address - Fax:956-602-1392
Practice Address - Street 1:1405 JACAMAN RD STE 106
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6225
Practice Address - Country:US
Practice Address - Phone:956-608-3050
Practice Address - Fax:956-608-3097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty